阜外医院感染性心内膜炎300例临床特征分析  

Clinical Characteristics, Pathogenic Distribution, Treatment and Prognosis of 300 Patients With Infective Endocarditis Hospitalized in Fuwai Hospital

作　　者：陈星伟[1] 刘亚欣[2] 于欢[1] 丁征[1] 王莹[1] 郑英丽[1] 谭慧琼[2] CHEN Xing-wei;LIU Ya-xin;YU Huan;DING Zheng;WANG Ying;ZHENG Ying-li;TAN Hui-qiong(Department of Pharmacy,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing（100037）,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院药剂科,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京市100037

出　　处：《中国循环杂志》2018年第11期1102-1107,共6页Chinese Circulation Journal

摘　　要：目的:分析近4年阜外医院感染性心内膜炎患者的临床、病原微生物特点、治疗及预后,提高该疾病的临床诊疗水平。方法:回顾性分析阜外医院2013年至2016年300例住院治疗的感染性心内膜炎患者的临床资料,着重分析其基础病因、致病微生物分布及临床转归情况。并对单纯药物治疗与手术治疗的临床及流行病学特点进行对比和分析。结果:300例患者平均年龄(40.0±15.7)岁。基础病因中先天性心脏病所占比例最高,106例(35.3%),其次为非风湿性心脏瓣膜病67例(22.3%)和心脏手术及介入治疗术后31例(10.3%),风湿性心脏病仅13例(4.3%)。临床表现最常见为心脏杂音280例(93.3%)和发热253例(84.3%)。并发症最常见的是心力衰竭226例(75.3%),其次为栓塞并发症50例(16.7%)。血培养阳性118例,阳性率为52.4%,其中链球菌仍然是最常见的致病菌,90例(76.3%),其次为葡萄球菌, 13例(11.0%)。300例患者中有274例(91.3%)有阳性发现(赘生物、瓣膜穿孔、脓肿、人工瓣瓣周漏等),237例手术或病理所见与超声心动图符合。住院病死率为3.0%。外科治疗治愈好转率明显高于内科治疗(96.6%vs 48.6%,P<0.001)。结论:感染性心内膜炎患者基础心脏病因最常见的是先天性心脏病。链球菌依然是感染性心内膜炎最常见的致病菌。感染性心内膜炎血培养阳性率低,超声心动图阳性表现成为最为重要的诊断依据。早期、有效、规律的抗菌药物治疗仍是治疗基础,及时的外科治疗可降低病死率。Objectives： To analyze the clinical features, pathogenic distribution, treatment and prognosis of patients with infective endocarditis （IE） hospitalized in Fuwai Hospital during the latest 4 years, and to improve the diagnosis and treatment of this disease. Methods： This retrospective study included a cohort of 300 IE patients hospitalized in Fuwai Hospital from 2013 to 2016. Predisposing cardiac disease, pathogenic distribution and clinical outcomes were analyzed. Clinical and epidemiological features of patients treated with medications or surgery were compared. Results： There were 228 male and 72 female patients in this cohort; the mean age was （40.0±15.7） years old. Among the IE patients, 35.3% patients had congenital heart diseases, 22.3% had non-rheumatic valve diseases, and 10.3% had history of PCI or heart surgery. Only 4.3% patients suffered from rheumatic heart diseases. Cardiac murmur （93.3%） and fever （84.3%） were the most common clinical presentations, Congestive heart failure was the most common complication （75.3%）, followed by systemic and pulmonary embolism （16.7%）. Incidence of positive blood culture was 52.4%. Streptococcus （76.3%） were the most common causative organisms, followed by Staphylococcus （11.0%）. 91.3% IE was detected by echocardiography. In-hospital mortality rate was 3.0%. Subgroup analysis showed that the cure rate of surgical treatment group was significantly higher than that of the medical treatment group （96.6% vs 48.6%, P〈0.001）. Conclusion： Congenital heart disease is the main underlying disease related to IE. Streptococcus is still the primary pathogen of IE. Due to the lower positive rate of blood culture, echocardiography serves as the most important diagnostic tool for infective endocarditis. Early, effective and regular antibiotic therapy is still the cornerstone of the treatment of IE. Cardiac sureerv treatment can reduce the mortality rate of IE.

关 键 词：心内膜炎 症状和体征 并发症 病原菌 

分 类 号：R541[医药卫生—心血管疾病]